Citardi M J, Kuhn F A
Department of Otolaryngology, St. Louis University, Missouri 63110, USA.
Am J Rhinol. 1998 May-Jun;12(3):179-82. doi: 10.2500/105065898781390109.
Despite its metabolic complications, systemic corticosteroid therapy remains a mainstay in the treatment of refractory polyposis after endoscopic frontal sinusotomy. Furthermore, topical nasal corticosteroids often fail, presumably due to the relatively small dosage actually absorbed by the polyps. In order to minimize steroid complications while increasing the locally absorbed dose, beclomethasone (approximately 1 cc, 84 mcg/100 microliters) was instilled under endoscopic guidance directly into the frontal sinus in 31 instances in 16 patients with postoperative frontal recess/sinus polyposis and mucosal edema. The frontal recess/sinus polyposis/edema resolved completely in 9 frontal sinuses, improved considerably in 7 frontal sinuses, improved minimally in 5 frontal sinuses, and remained unchanged in 10 frontal sinuses. No complications were noted. AM cortisol levels remained in the normal range. Endoscopically guided frontal sinus beclomethasone instillation should be considered for the treatment of refractory postoperative frontal sinus/recess polyposis/edema. Further basic and clinical research into the pathophysiology of the nasal mucosa is also warranted.
尽管存在代谢并发症，但全身皮质类固醇疗法仍是内镜下额窦切开术后难治性息肉病治疗的主要手段。此外，局部鼻用皮质类固醇常常无效，推测是由于息肉实际吸收的剂量相对较小。为了在增加局部吸收剂量的同时将类固醇并发症降至最低，在16例术后额隐窝/鼻窦息肉病和黏膜水肿患者的31个病例中，在内镜引导下将倍氯米松（约1毫升，84微克/100微升）直接注入额窦。9个额窦的额隐窝/鼻窦息肉病/水肿完全消退，7个额窦有显著改善，5个额窦改善轻微，10个额窦无变化。未观察到并发症。上午皮质醇水平保持在正常范围内。对于难治性术后额窦/隐窝息肉病/水肿的治疗，应考虑在内镜引导下进行额窦倍氯米松滴注。对鼻黏膜病理生理学进行进一步的基础和临床研究也是必要的。
